The present invention generally relates to medical instruments used to prevent bleeding and, more particularly, to a compress apparatus which employs multiple mechanisms to adjust the apparatus for use with patients of various sizes and to permit controlled application and release of the pressure applied to a puncture site on the patient.
Medical procedures involving the puncture of a blood vessel for purposes of entry of a catheter or a needle are commonly performed. One such procedure is a cardiac catheterization in which the femural artery in a patient's groin area is punctured to allow passage of a long, fine catheter through the artery and into the chambers of the heart. The cardiac catheterization procedure aids in diagnosis of various heart disorders and anomalies.
Following withdrawal of the catheter, pressure must be applied to the groin area at the location of the puncture in the artery to allow coagulation to take place to prevent bleeding. Several approaches to apply the necessary pressure have been followed. One approach is for a physician or nurse to manually apply pressure to the site of the puncture for an extended period of time. However, this is time consuming and restricts the freedom of such medical personnel to render other urgent medical care.
Another approach is to use a mechanical device to apply the pressure. A device designed for this purpose is disclosed in U.S. Pat. No. 3,779,249 which issued to Semler. This device, called an artery clamp, includes an upright tubular support member mounted on a flat base, and an arm structure mounted from the support member in cantilevered fashion overlying the base. The arm structure is mounted for vertical slidable movement along the upper end of the support member. Detachably mounted at the outer end of the arm structure is a relatively inflexible. disk-shaped pressure pad formed from a transparent plastic material.
Before removing the catheter from the patient, a physician or nurse places the base of the clamp device under the patient's thigh and slidably positions the arm structure so that the pressure pad is directly over the puncture site. As the catheter is withdrawn, the arm structure is manually moved down toward the base, causing the pad to compress the artery and prevent bleeding. The resulting upward pressure on the pad causes slight upward pivoting of the arm structure relative the upright support member which locks the arm structure in position on the support member. After a period of time sufficient for coagulation, the arm structure is unlocked by manually operating a release lever mounted thereon. If bleeding recurs, the user may recompress the blood vessel by again pressing down on the arm structure.
Later U.S. Pat. No. 4,572,182 to Royse proposes that the pressure pad used with the artery clamp of the Semler patent have a V-shaped notch formed through it. This permits the pad to apply pressure to the puncture site prior to complete removal of the catheter. The V-shaped notch receives the catheter as the latter is being withdrawn from the puncture site.
The above described artery clamp of the Semler patent is advantageous in that it relieves a physician or nurse from the restrictive task of manually applying pressure to the puncture site. However, it embodies several limitations which make it less that an optimum solution to the problem of preventing bleeding in a reliable manner.
One limitation of the Semler clamp device is that its arm structure is of fixed length. As a consequence, when used with patients of slender or small size, the device must be positioned substantially outwardly from the patient's side in order to have the pressure pad properly located with respect to the puncture site. This is undesirable from the standpoint of stability of the device during use. Another limitation is that there is no easy way to adjust the amount of pressure being applied to the patient once the arm structure has been moved down and locked into position, especially in view of the fact that locking of the arm structure is dependent upon an upward reaction force being applied to it by the patient's body. Although the arm structure can be locked at an infinite number of different positions along the support member, there is no means to accurately adjust the arm structure to any one selected position. Instead, trial and error is involved to find the approximate position required to apply the proper amount of pressure.
Yet another limitation is that the procedure for removal of the pressure pad is somewhat jerky. When the pressure pad is abruptly moved away from the patient, the blood clot which seals the puncture wound may tear, allowing bleeding to resume. Still another limitation is that the conical socket used to mount the pressure pad to the outer end of the arm structure does not allow significant conformance of the attitude of the pad to the contour of the patient's body at the puncture site. As a result, a situation is likely to arise where an uneven distribution of pressure is applied to the site. Yet another limitation is that the flat bottom surface of this pad is bordered by a relative sharp edge which may tend to dig uncomfortably into the patient's skin if the upper torso of the patient is raised slightly. Often it is desirable, however, to elevate the upper torso to facilitate normal breathing patterns and enhance patient comfort.
Consequently, in view of the above-cited limitations, as well as others embodied by the construction of the Semler clamp device, it is readily apparent that a need exists for a device which addresses the limitations of the prior art and provides improved operation and patient comfort.